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At last – Chloride is nephrotoxic

For years I have been trotting around the world telling everyone that NaCl 0.9% is evil, because each litre delivers 50mmol of HCL and chloride is nephrotoxic. This belief has come from a series of studies in volunteers (reduced GFR, reduced splanchnic perfusion, reduced cortical blood flow) and observations (increased contrast nephropathy with NaCl versus … Continue reading

No I won’t do it and here is the proof!

As a junior doctor how many times were you called to replace an iv catheter on a veinless patient because with was 3 days old (and “hospital policy” and all that). There was no point asking to see the evidence on which this “policy” was based. Whatever! – here is the counter evidence, and it … Continue reading

Just when you thought it was unsafe….HES again!

A couple of weeks ago I announced the imminent death of colloid. Now it’s back with another “Safe” trial (known as CHEST) from our colleagues in Australia and New Zealand (here). The study enrolled a colossal number of patients (7000) to either isotonic saline (IS) or Voluven (R). This is a 130/0.4 tetrastarch in isotonic … Continue reading

The sweet smell of obesity

You may recall a movie from a few years ago called “Super Size Me” that featured Morgan Spurlock eating nothing but McDonalds food for a month. If offered a super sized meal, he said – yes. He became lethargic, gained weight and developed a fatty liver. The message was that if you ate highly calorific fatty food, you … Continue reading

Don’t Understand Balloon Pumps – don’t bother

Alas – another intervention bites the dust. For decades the intra-aortic balloon pump has been heralded as the great savior of the patient with cardiogenic shock. If you have always found these devices confusing (when to use, when to wean, what difference 1:1 versus 1:2 augmentation etc), then worry not: they are heading to the … Continue reading

Regional or General Anaesthhesia for Hip Fracture

A 78 year old female patient is brought to the operating room with a fractured hip. She tells you that she wants to “go asleep” for the operation. How do you advise her? Two papers in July’s Anesthesiology have shed light on this issue. Both studies mine large databases and so care must be taken … Continue reading